I am struggling with patient families lately.
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I am fed up with patient families treating the hospital like a family reunion site. I am tired of the family members that insist on staying the night, why? In some cases I get it. But when your... Read More

I am fed up with patient families treating the hospital like a family reunion site. I am tired of the family members that insist on staying the night, why? In some cases I get it. But when your boyfriend has the flu or your nana needs her rest and she won't rest with a room full of visitors, please leave and go home. I am very capable of doing my job without you laying there with one eye opened making sure I do what you think I should. These are all things I wish I could say, but damn those customer satisfaction surveys.

Ah, but you can. You can get away with saying just about anything if you just say it right. Of course every situation is different, but you could say something like "I understand how concerned about Nana you must be. I would feel the same way in your shoes. But I've been doing this for a while, and I promise you I will take good care of Nana. She will be just fine! Why don't you go home and get a good night's sleep and come back in the morning?" Be completely sincere when you say this, and if they seem reluctant, ask them about their concerns. Sometimes just getting their concerns out in the open and having them addressed will go a long way to helping a family member trust you.

Some people feel like they need permission to leave their loved one overnight. Some people can sense from your nonverbal communication that you'd rather they weren't there, and it feeds into their mistrust.

And yes, it's true that some people are just jerks and won't respond to any of your most sincere efforts. But it is worth a try. You might be surprised!

Dec 29, '12

I think there needs to be some teaching on the overall effectiveness and benefits of family-centered care. Seems like a knowledge deficit kind of thing. Even with family centered care, appropriate limits can be set. It doesn't have to be the kind of nightmare some have described--accept in the ED. That's a whole different world, and it's a lot harder to set the same kind of limits in that environment. The nurses that work there--well, to them I give the most sympathy. Even then, the excellent ED nurses know the importance of family. But some of them are obnoxious and out of control. This should be straightened out, but as I said, that can be tough to do in the ED for a number of reasons. Even in the most organized EDs, chaos can ensue out of no where. Overall, it does depend on the family.

About the family in the bed. Well, in peds, we have had moms or dads in the bed with their children. It's problematic for them to sleep there, but they can certainly visit there. We have had teens that have had their boy or girl friends lay down in the bed just to be close. It's not a big deal. They don't stay there. Really, it's also about picking your battles.

Now if a kid is fresh out of the OR with lines and frequent chest tube suctioning or really in a critical state, it's obvious no one is going to be in the bed with the kid. Usually the thing speaks for itself. And usually people are scared at all the stuff connected to and coming out of the patient. So, come on. That's a lot different. A kid on ECMO, same darn thing. You have to look at each situation and what is appropriate. This is called having sound judgment.

Bottom line, however, is that is most cases, family-centered care works. People have to be educated on it, and be open to make the appropriate paradigm shift. From what I have seen with a number of folks and institutions that are resistant to it, they are ill informed about it, or there is a control issue. When attitudes of extreme control get in the way, the patient often loses out. The family is a part of them just as any part of their body is. If you set appropriate boundaries, it works just fine.

Dec 29, '12

Also, when I have been overnight with my mother or father, it was for their support and protection. I could write a book about the incredible mess up and near death errors and such. Don't have time for that right now. You have to wait til the book comes out.

Dec 29, '12

I used to love having family members around, knowing my patients were loved and cared for...however, more and more family members are acting mentally ill and in need of more care than my patients (and my patients are PCU!), from the older lady who sat second guessing, repeating herself, asking the same thing over and over again (not sure, but almost positive she had beginning stages of dementia from her behaviors!), arguing with my patient when he said anything to the psychotic daughter who thought her mother having been hospitalized entitled her, the daughter, to have a meltdown and go around calling people names and being just downright nasty (and when we requested she lower her voice in deference to the other patients in the bay she pretty much told us where to take it!) to the crazy woman who decided it was acceptable to get involved in a yelling match with her mother (again, in an open bay in front of other patients)...
Less and less often do I encounter family member types of bygone years when I was proud to be able to assist family...more and more I feel like backing away slowly from the crazy people and hiding any sharps...tonight, I even had a family member shaking an object in my face because she did not get what she wanted...I was a breath away from having her removed by security. Luckily, our mgmt was able to diffuse the situation.
However, it is getting to where I think the sweet little old man who asked me nicely for my scissors so he could stab me with them is actually safer to be around than many of these so called "loving" family members who act totally unhinged at the drop of a hat.
To all the amazing family members out there who actually try to be a blessing to their family member and help by being a part of the treatment team, God bless you and don't quit.

Last edit by maelstrom143 on Dec 29, '12
: Reason: addendum

Dec 29, '12

this happened to me yesterday and that is why I am online submitting applications today, I have too much education and experience to be treated any kind of way.

was the man her husband perhaps boyfriend etc. there are many reasons that you are unaware of why they are together like that. I don't feel that correcting them as you say was the appropriate thing to do right yet. Unless they were teenagers messing around and being stupid or some biker trying to make it with his chic sorta thing. I am not saying your wrong but going about your business or saying hey you two whats up i'll just be a few etc. woukld have made your life much more pleasant and them happy.Unless of course it got out of hand i would have called the supervisor to handle it. Number one your to busy to have to mess with it anyway . By correcting them that opened the door to defensiveness and the rest of your night will be dreadful. Try never to create a negative atmosphere for instance correcting a pts. behavior like what happened. you can correct that buy using the power of positive energy, if u can do that you will never have pt. relation problems. Like I said previously walk in say something like okay you two I need to check something give her a med and i'm out of here if u need anything just let me know thanks have a goodnight whatever. Every body walks away happy. I would almost bet next time you walk in he will be in the chair and you are their best friend. You set the stage and minded your own business, though of course you keep an eye if things got out of hand. but then call the supervisor thst keeps you out of harms way. Good luck to you and may the "force be with you"! Always keep a positive atmosphere and you will always have control.

Whether the man was her husband, her boyfriend or her parent or child, there are appropriate ways to behave in public and there are inappropriate ways to behave in public. If they were behaving inappropriately, there's no reason for nurses to have to put up with that. (And I fail to see why "some biker trying to make it with his chic" is less appropriate than the patient's husband or boyfriend trying to "make it with" her. Bikers and their chicks can actually be married or in long term, loving relationships.) Despite all the current nonsense about "patient centered care" and "customer service", a hospital room is a public place. There is no expectation that the hospital staff is just going to leave you alone to do your thing no matter what they hear, smell or see on the monitor. The hospital staff is responsible for keeping the patients safe, and we'll do that.

It's difficult for me to take your advice seriously with the spelling, punctuation, grammar, etc. are so dreadful. But it seems to me that you're saying to just let them do their thing so you have a more pleasant shift. I disagree. There are some times when someone's behavior NEEDS to be corrected, and although I wasn't actually there to witness it, I'm going to allow for the possibility that that may have been one of those times.

Please do yourself a service and learn to write professionally and well. People will take you more seriously.

u know what those family members are displaying symptoms of guilt or showing nana that who is doing for her so when passes she will b remembered families r a trip. but slow down try looking at their behavior from a psychological aspect its very interesting it will also give you insight to why instead of making you crazy. Like they say reason for everything been ther done to many times and then some. check it out though and observe family behavior because it can get down right outrageous its not norma they are up to something or want something and asking for thi and that and scheduling nana meds etc is their way of showing u how much they care for nana its displaying their guilt cause they havent seen nana in years and could care less and they r after something. people are the most interesting creatures on Earth. Good Luck!

The family who feels guilty about ignoring Nana for years is usually a family that cannot be pleased. They're not interfering for any rational reason -- they're just throwing their weight around because they want to "prove" that they care. A family who cannot be pleased is probably a family who is interfering with Nana's care and comfort. The best place for them is at home, getting a good night's rest. I try to encourage that.

Dec 29, '12

@SCSTxRN: YOU are an example of the family we like to have around. Helpful, aware of your loved one's safety needs, etc. Unforunately, most family is, as aforementioned in a previous post, trying to sneak in KFC for dysphagic nana, or having family reunions in the middle of the ICU, yelling at me because I won't tell you (the long-lost cousin who flew in from Timbucktoo) the intricate details of my patient's past 3 weeks in hospital. One thing that I will be snippy about is HIPPA.

Most of the nurses I know have stopped even trying to enforce any rules about visitation because we know that administration will roll over on us. What's the point of even having rules. Things have gotten to the point where, in the name of "satisfaction," we have lost their respect.

Dec 29, '12

Although I agree that pts should have advocates , I feel the "difficult" and demanding family members are becoming increasingly worse. I have had family members pull me aside for things we have already discussed many many times. I will gladly review your family members meds with you if I am allowed to legally but not 5 times in 2 days because you can't remember or lost the copy of the meds list I gave you. If you expect me to be on top of everything then I expect the same of you. I have also had family members come into another pts room to get me because there family member wants a glass of juice or can't figure out how to work the call bell and that is just not acceptable. But you gotta just keep smiling....

Dec 30, '12

"Family Centered Care" is most appropriate for pediatric settings.

When working with the adult population, many institutions (mine included) promote "Patient Centered Care", in which the individual's preferences, family system, cultural background, etc. are taken into account. The patient is an active participant in their own plan of care, and it is the patient who is the focus of everything we do.

If Nana prefers having a family member spend the night, then that can certainly be accomodated. If, however, having another family member present is having a negative impact on Nana's health status, then it is completely appropriate for the nurse to ask the family to leave. It is Nana's well being that drives the decisions regarding family presence, not family preference. Nana is an adult human being whose autonomy should be respected and protected as much as is possible.

Dec 30, '12

Have to agree with OP for the most part. Of course, we all love the helpful, cooperative family members, but I think he/she was referring to the kind we too seem to have a run on lately: tying up staff for hours repeating the same questions to the point of interfering with patient care, stripping our pantry of all foodstuffs including tube feed formulas, trashing waiting rooms, and best of all, injecting patients with Lord knows what when the q2hour Dilaudid just wasn't cutting it. I swear we are using more Narcan than the ER.

I would love to report every single test result and interpret it for you, and tell you exactly what the doctor thinks it may be and when your loved when will be discharged, but it don't work that way. And by the way, thank you for calling the CEO to complain.
I know you are hungry and our cots are uncomfortable so just go home. I will get written up if I give you food meant for patients and the cots are hard and narrow for a reason. Swearing at me and threatening to sue won't change anything.
Yes, cousin Bobby is hurting a great deal, but short of general anesthesia we can't take his pain completely away. This could be a wake up call for him to consider rehab, if he survives endocarditis. And if we can't wake him up and his resps are 6, we will give him Narcan and then he will know what pain is.

@SCSTxRN: YOU are an example of the family we like to have around. Helpful, aware of your loved one's safety needs, etc. Unforunately, most family is, as aforementioned in a previous post, trying to sneak in KFC for dysphagic nana, or having family reunions in the middle of the ICU, yelling at me because I won't tell you (the long-lost cousin who flew in from Timbucktoo) the intricate details of my patient's past 3 weeks in hospital. One thing that I will be snippy about is HIPPA.

Most of the nurses I know have stopped even trying to enforce any rules about visitation because we know that administration will roll over on us. What's the point of even having rules. Things have gotten to the point where, in the name of "satisfaction," we have lost their respect.

This this, and this.

Dec 30, '12

What drives me crazy is when people bring babies/toddlers and allow them to crawl on the floor...